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NPI Profile for STEVEN J CLARK in GRAY, GA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Optician |
156FX1800X | 96[5] | Optician |
| NPI # | 1619197779 |
|
| Status | Active | |
| Credentials | LD0001859 | |
| Entity | Individual | |
| Enumeration date | 04/30/2007 | |
| Last updated | 07/08/2007 - About 19 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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STEVEN J CLARK
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STEVEN J CLARK, LD0001859